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BDS3 > TMJ wilkinson > Flashcards

TMJ wilkinson Flashcards

1
Q

What are SIX signs/symptoms of TMD?

A
  • Tender muscles
  • Tender TMJ
  • Ear signs (pain, blockage)
  • Limited opening (reflex opening inhibition due to inflammed TMJ)
  • Clicking/locking
  • Crepitus (hard and soft)
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2
Q

What is ONE biological reason why women might present for treatment of pain 3x more than men?

A

Oestrogen potentiates pain at a spinal level (peak pain seen in child bearing years)

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3
Q

What are FIVE causes of jaw pain that TMD is NOT considered?

A
  • Iatrogenic trauma
  • Infection
  • Neuropathic pain (trigeminal neuralgia, migraine, atypical odontalgia)
  • Neoplasia
  • Non-parafunctional tooth wear
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4
Q

What was atypical odontalgia previously known as?

A

Atypical odontalgia was previous known as phantom tooth pain

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5
Q

Why might an impression of the mandible be less accurate when the patient is at max opening?

A

The mandible can flex laterally up to 2mm during max opening.

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6
Q

Which ligament acts as the posterior restraint (prevents condyle moving too posteriorly)

A

Temporomandibular ligament (aka. lateral ligament)

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7
Q

What is the reasoning for wanting to change centric relation from most posterior to most anterior position?

A

We want centric relation to coincide with a physiological (ie. not pathological) position of the condyle. Most posterior is stretching the TM ligament to the max = not physiological, so most anterior makes sense.
NOTE: definition includes condition that disk is in place.

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8
Q

Which is thinner, the anterior thick or posterior thick portion of the articular disk of the TMJ? Why?

A
  • Anterior thick (in adults)

- Due to loading wear and tear and lack of regenerative ability (low blood supply)

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9
Q

Which dictates the position of the other: TMJ vs. teeth. What is ONE implication?

A

Teeth dictate the position of the TMJ. Implications for ortho.

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10
Q

What is the main function of the upper head of the lateral pterygoid?

A

It contracts to produce a stiff ‘leather strap’ to keep the foot of the articular disk in line with the condyle during final/slow closing (it is attached to both).

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11
Q

What is the main role of the TMJ?

A

To aid in mastication (gaining nutrients)

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12
Q

What are SIX aspects of an ideal TMJ?

A
  • High speed movement
  • Minimal friction
  • Minimal loading
  • Congruency
  • Stability in centric
  • Pressure compensation
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13
Q

Why do ear symptoms occur during TMD?

A

Neural confusion between TMJ and ear (not due to residual ear elements in TMJ)

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14
Q

How does the articular eminence differ from birth to adulthood?

A

It begins fairly flat at birth and becomes curved towards adulthood (influenced by position of teeth)

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15
Q

What is so special about the articular surface of the TMJ and sternoclavicular joint vs. the rest of the body?

A

TMJ and sternoclavicular joint articular surfaces are made of dense fibrous tissue, the rest of the body’s articular surfaces are hyaline cartilage.

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16
Q

What are THREE differences between hyaline cartilage and fibrous tissue?

A
  • Glassy (hyaline) vs. dense white (fibrous)
  • Good for compressive and torsion (hyaline), better for shearing than compressive (fibrous)
  • Some regenerative ability (hyaline), adapts in response to loading (fibrous)
17
Q

What are the SIX layers of a fibrous joint? (name some functions where necessary)

A
  1. CT lining
  2. Mesenchymal layer (contain stem cells that aid in adaptation through production of fibrous cartilage)
  3. Transitional layer (for fine tuning during different stages of dentition. Not present in elderly)
  4. Fibrous cartilage (articular surface)
  5. Compact bone (condyle)
  6. Spongy bone (condyle)
18
Q

Why does the TMJ need pressure compensation and how is this acheived?

A
  • Condyle movement in/out of the mandibular fossa creates a piston effect producing pressure
  • Compensated via retrodiscal tissue taking its place, eliminating piston pressure
19
Q

Superficial vs. Deep masseter:

  • Location
  • Roles
  • Marathon vs. sprinter?
A 
Masseter muscle is a sprinter. Sustained contraction may result in muscle soreness.
Superficial
- Force generator for mastication
- Placed over dentition
Deep
- Stabiliser
- Placed over TMJ
20
Q

When does the masseter activate vs. temporalis?

A

Temporalis activates quite early, with masseter only coming on just before bolus is pierced.

21
Q

Where can pain from the temporalis present as?

A
  • Headache (it runs high up the skull)

- Pain behind the eye (anterior portion goes deep near eye)

22
Q

What reflex is the digastric muscle prominent in?

A 
Unloading reflex (tenses when biting into something that might break, activates after the break)
NOTE: it depresses mandible when hyoid is held in place
23
Q

How does condyle movement at the working (chewing) side and non-working side differ?

A
  • Working side moves posterior to a point behind the original position and moves anterio-superiorly against the eminence
  • Non-working side keeps moving anterior after working side starts moving posterior

-> Net effect: jaw swings laterally towards working side and moves back to intercuspal to attack bolus.

24
Q

What bony structure takes significantly more load than the neighbouring bone during chewing?

A

Articular eminence
(mandibular fossa takes very little load. As a result, eminence is very thick, while superior portion of fossa is very thin.)

25
Q

When chewing, which condyle takes the most load: ipsilateral or contralateral? How might this be relevant clinically?

A

Contralateral, because the bolus is taking most of the load at the ipsilateral side.
Clinically, someone may be more comfortable chewing on their sore side vs. good side.

26
Q

What is unique about loading the 3rd molars vs. areas more anterior in the mouth?

A

It produces an unloading effect on the TMJ, theoretically predisposing it to injury.

27
Q

What are the names of the THREE main click patterns of TMJ dysfunction?
Are the clicks painful or painless?
Out of the three, which most likely requires treatment?

A

Eminence, Deviation in form, Anterior displacement.

  • Clicks are usually painless.
  • Anterior displacement, because with reduction could progress to without reduction and jaw will then have a ‘locked’ feeling as condyle is unable to reclaim disk.
28
Q

Eminence:

  • Where does the click/s occur?
  • Description of what’s happening
  • Cause
  • Treatment
A
  • Click on wide opening, no click on closing
  • Click due to condyle moving past tip of eminence
  • Cause: Starts due to clicking habit
  • Tmt: Stop the habit (dont open too wide e.g. during yawning, dont chin sit ie. moves condyle anteriorly)
29
Q

Deviation in form:

  • Where does the click/s occur?
  • Description of what’s happening
  • Cause
  • Treatment
A
  • Click usually on middle third with reciprocal click on closing
  • Click due to thickening of fibrous portion of joint in response to biomechanical loading
  • Cause: Pencil biting or clenching
  • Tmt: Stop the habit and hopefully deviation in form will decrease
30
Q

Anterior displacement:

  • Where does the click/s occur?
  • Description of what’s happening
  • Cause
  • Treatment
A
  • Click anywhere on opening (depends on severity of anterior disk displacement), click on final closing (at intercuspal position)
  • Click when condyle moves back under disk and click when disk slips off to the front of condyle
  • Cause: Natural variation, macro/microtrauma, increased friction (disk can get gluey on eminence)
  • Tmt: ??
31
Q

What are TWO main differences between diurnal (daytime) and nocturnal parafunction?

A
  • Diurnal is light forces, nocturnal is heavy forces

- Diurnal associated with oral habits

32
Q

Histologically, what position would you usually find the junction between retrodiscal tissue and thick portion of the disk?

A

12 o’clock

BDS3 (22 decks)

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